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Become a Member

Thank you for your interest in becoming a member of 9/11 Health Watch.

To help us better serve you, tell us more about your experience on September 11th. Review the questions carefully and answer as much as you can or click thru to go to the next section. We are here to help you and ensure that you, the heroes and survivors of 9/11, receive the care you deserve from a nation grateful for your selfless sacrifice.

Contact Information

Email*First Name*Last Name*Address*City*State*Postal Code*PhoneAre you a union member?YesNoIf you answered 'yes,' please identify your union.Please identify your location on September 11th: World Trade Center, Pentagon, or Shanksville, Pennsylvania. If you were at Ground Zero, please describe your activities.If you were at Ground Zero, please identify how long you were at Ground Zero. (Date format: MM-DD-YYYY to MM-DD-YYYY)If you were not at Ground Zero, but want to be a member of 9/11 Health Watch, please let us know if are you a spouse, relative, or friend of someone who was at Ground Zero. Then, skip to "Complete."

If you are a first responder, survivor, or a volunteer? Select the appropriate tab above in Step 2.

First Responders

Police

If you were police, please identify your affiliation.If you answered 'other' to the police identification question, please identify what other Department.

Fire

If you were fire, please identify your affiliation.If you answered 'other' to the fire identification question, please type in what other Department here.

Construction

If you were a construction worker, please identify your trade.If you answered 'other' to construction worker trade, please identify other trade here.If you were a utility worker, were you communications or electrical?

State or City Employee

If you were a non-federal public employee, please identify your affiliation.If you answered 'other' to non-federal public employee, please identify your department.

Federal Employee

If you were with FEMA, please identify your team name.If you were a federal employee, please identify your agency.If you answered 'other' to federal employee, please identify your department.

Military

If you were in the military, please identify your branch.If you answered 'other' to the military, please identify your unit.

Please continue on to Step 3 if you are currently participating in the WTC Health Program. If you are not, skip to Step 4 and submit your membership.

Survivors

The Zadroga legislation provides medical treatment for the injuries of injured and ill 9/11 Responders and Survivors. Survivors are area residents, students ( K thru 12 and college students) and workers (office workers, retail service jobs, custodians) in the affected area.

Did you live, work, go to school, in Lower Manhattan below Houston Street, or in Brooklyn 1.5 miles from the WTC site (DUMBO, Brooklyn Heights, Vinegar Hill)?Resident of Lower Manhattan or western BrooklynEmployed in a Downtown or western Brooklyn officeStudent at Nearby School or CollegeOtherIf you selected 'other,' please describe here.Please tell us if your home, school, or workplace was evacuated.YesNoAbout how long did it take to return to home, school, or work? (Date format: MM-DD-YYYY to MM-DD-YYYY)Please let us know if your workplace, home, or school was ever cleaned.YesNoIf so, when was your workplace, home, or school cleaned? (Date format: MM-DD-YYYY)

Please continue on to Step 3 if you are currently participating in the WTC Health Program. If you are not, skip to Step 4 and submit your membership.

Volunteers

If you volunteered with an organization at Ground Zero, please identify them here.If you answered 'other' to the volunteer organization question, please identify here.

Please continue on to Step 3 if you are currently participating in the WTC Health Program. If you are not, skip to Step 4 and submit your membership.

World Trade Center Health Program

If you participate in the World Trade Center Responder Program, please identify the location.If you participate in the FDNY World Trade Center Medical Monitoring Program, are you:If you participate in the National Program, please identify your health care provider (with name and city).If you participate in the World Trade Center Survivor Program, please identify the location.